Self Assessment Questionnaire

Self-Assessment of Cultural Competence

As a member of an organization, the knowledge you have of yourself and others is important and reflected in the ways you communicate and interact. This individual assessment instrument was developed to assist you in reflecting upon and examining your journey toward cultural competence. The following statements are about you and your cultural beliefs and values as they relate to the organization. Please check the ONE answer that BEST DESCRIBES your response to each of the statements. |Individual Assessment |Almost | | |Almost |
| |Always |Often |Sometimes |Never |
|1. I reflect on and examine my own cultural background, biases and prejudices related to race, culture | | | | |
|and sexual orientation that may influence my behaviors. | | | | |
|2. I continue to learn about the cultures of the consumers and families served in the program, in | | | | |
|particular attitudes towards disability; cultural beliefs and values; and health, spiritual, and | | | | |
|religious practices. | | | | |
|3. I recognize and accept that the consumer and family members make the ultimate decisions even though | | | | |
|they may be different compared to my personal and professional values and beliefs. | | | | |
|4. I intervene, in an appropriate manner, when I observe other staff engaging in behaviors that appear | | | | |
|culturally insensitive or reflect prejudice. | | | | |
|5. I attempt to learn and use key words and colloquialisms of the languages used by the consumers and | | | | |
|families served. | | | | |
|6. I utilize interpreters for the assessment of consumers and their families whose spoken language is | | | | |
|one for which I am not fluent. | | | | |
|7. I have developed skills to utilize an interpreter effectively. | | | | |
|8. I utilize methods of communication, including written, verbal, pictures, and diagrams, which will be| | | | |
|most helpful to the consumers, families, and other program participants. | | | | |
|9. I write reports or any form of written communication, in a style and at a level which consumers, | | | | |
|families, and other program participants will understand. | | | | |
|10. I am flexible, adaptive, and will initiate changes, which will better serve consumers, families, | | | | |
|and other program participants from diverse cultures. | | | | |
|11. I am mindful of cultural factors that may be influencing the behaviors of consumers, families, and | | | | |
|other program participants. | | | | |

Developed by the AUCD Multicultural Council
Adapted in part from Promoting Cultural Diversity and Cultural Competency Self Assessment Checklist for Personnel Providing Services and Support to Children with Special Health Needs and Their Families by Tawara D. Goode, Georgetown University Child Development Center.